Flashcards in Pneumonia Deck (28)
What is diffusion?
exchange of gas molecules (oxygen and carbon dioxide) from areas of high concentration to low concentration.
Why is the post op patient at risk for atelectasis?
because of the effects of anesthesia and restricted brathing with pain
-In ARDS lack of surfactant contributes to widespread atelectasis
Explain bronchial circulation?
arises from thoracic aorta
bronchial circulation prvides oxygen to the bronchi and other pulmonary tissues.
-deoxygenated blood returns from the bronchial circulation through the azygos vein into the superior vena cava
Explain assessment of the respiratory system?
-symmetry of chest expansion: hands at tenth rib, thumbs meet spine, deep breath, thumbs should move 1 inch
-Trachea: place index finger just above suprasternal notch and gently press, trachea should be at midline
-Palpate fremitus: vibration of chest wall produced by vocalization, most intesnse adjacent to sternum, and between scapulae, not increase, decrease, or absence of fremitus
-auscultate in planned sequence, have patient breathe through the mouth, if patient is in respiratory distress or will tire easily start at the bases
What are the 3 normal breath sounds?
-bronchial: high pitched, air blowing through a hollow pipe, heard alongside trachea
-bronchovesicular: medium pitch and intensity, heard anteriorly over mainstem bronchi on eitherside of sternum and posteriorly between scapulae
-vesicular: soft, low pitched, gentle, rustling sounds, heard all over lung areas except major bronchi
Adventitious breath sounds?
fine and course crackles
pleural friction rub
Fine crackles (formerly rales):
-short duration, discontinuous, high pitcjed, heard just before end of inspiration
long duration, discontinuous, evident on inspiration and at times expiration
partial obstruction of larynx or trachea
Pleural friction rub?
harsh sound like two peices of leather being rubed together
is positive (abnormal) - when person says E but it is heard as A
is positive (abnormal) - when a person says 99 and the words are easily understood through the stethscope
What happens when the conditions that increase lung density or when the lung is consolidated (pneumonia)?
there will be positive (abnormal) voice sounds
What do you inspect the finger for?
Clubbing: causes of cyanosis include hypoxemia or decreased cardiac output
Why is sputium obtained?
-for analyisis to identify pathogenic organisms and to determine whether malignant cell are present.
-before antimicrobial therapy is initiated or evaluate effectiveness of medications already given
How can sputum samples be obtained?
expectoration (if patient can'texpectorate inhalation of irritating aerosol, usually hypertonic saline this is called sputum induction.)
How do you observe the sputum?
presence or absence of blood
When should sputum be tested for C&S (culture and sensitivity)?
-before antimicrobial therapy is initiated
-identify infecting organsism
Test results and clinical significance?
-bacterial infection - pneumonia
-atypical bacterial infection (TB)
Sputum for cytologic exam?
-if diagnosis of cancer is considered
-abnormal chest x-ray film result
-productive cough and nothing visible on bronchoscopy
-monitor smokers with atypical changes
Sputum Test results:
-benign cellular changes
most commonly related to infection (bronchiectasis), exposure (asbestosis), or viral pneumonitis
What do astham patients often have from sputum test results?
What are ABG's used for and what are they?
-used to monitor patients on ventilators, critically ill nonventilator patients, establish preoperative baseline parameters, and regulate electrolyte therapy.
-pH, Pco2, HCO3, Po2, O2
What is pH?
hydrogen ion concentration int he blood
What is Pco2?
partial pressure of CO2 in the blood. A measurement of ventilation.
What is HCO3?
bicarbonate ion measures the metabolic (renal) component of the acid base equilibrium.
What is Po2?
indirect measurement of the O2 content in the arterial blood